The document outlines an agenda for a presentation on the evolution of computers from 4000 BC to 2010. It discusses the early history of computing devices like the abacus and the Harvard Mark I computer. It then covers the current state of the healthcare IT market and challenges like data fragmentation across different systems. The rest of the presentation focuses on strategies for successful implementation of electronic medical records systems, including selecting the right vendor, training staff, and addressing common reasons for IT project failure like lack of planning and physician buy-in.

1. © 2010 The Coker Group 1

2. Agenda
 The computer evolution from 4000 B.C. to 2010
 Current State of the Market
 Where have we been - Where we are going
 How to buy the right system for your practice
 Top 10 most common mistakes to avoid
 Top 20 reasons for I.T. failure
 Summary
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© 2010 The Coker Group 2

3. Life Before Computers
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 Memory was something that you lost with age.
 An application was something you filled out
for employment.
 A cursor was someone who used profanity.
 A virus was the flu.
 A hard drive was a long trip on the road.
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4. Technology evolution from
4000 B.C. to 2010
in 5 minutes
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5. 4000 to 1200 BC inhabitants kept
records on clay tablets
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6. 3000 BC the Abacus
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7. In 1642 Blaise Pascal invented the Pascaline as an
aid for his father who was a tax collector
collector.
(it could only add)
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8. Pinwheel calculator with 10-digit setting register, made in
Sweden in 1945.
S d i 1945
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9. One early success was the Harvard Mark I computer which was built as
a partnership between Harvard and IBM in 1944. This was the first
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programmable digital computer made in the U.S. The machine weighed
5 tons, incorporated 500 miles of wire, was 8 feet tall and 51 feet long.
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10. The first-ever computer mouse in the hand of its inventor
Doug Engelbart. - 1968
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11. 1970 Unix is developed at Bell Labs by
Dennis Rit hi and K
D i Ritchie d Kenneth Th
th Thomson.
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12. 1981- IBM introduced the first desk-top computer
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13. Microsoft Version 1.0 was released in 1985, the more commonly known
Windows version was released in 1990 which was version 3 1
1990, 3.1
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14. First Laptop - 1979
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15. The first chip to implement its 64-bit architecture - 1992
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16. 2010
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17. Our Progress in Healthcare
50% 40% 10%
use this device use this device use this device
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or desktop 17

18. Current State of the
Market & Vendors
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19. Current State of the Vendors
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20. Putting it into Perspective
Software
Interfacing
•Practice
Practice
•Pharmacy
Management
•Transcription
•Reporting
•Hospitals
Hospitals
•Coding
C di
•Lab
•Document
Imaging •PACS
•EMR
Portals Devices
•Messaging •Desktops
•E-Health •PDAs
•Patient Access •Tablet
© 2010 The Coker Group 20

21. Standalone
•Interfacing Development
LAB
•Fragmentation of data challenges
F t ti f d t h ll
EMR •Multiple points of entry
Server & Rack
60 to 70K
•Unable to share with other
Radiology E-Mail
providers
•Version control
•Multiple vendors
•Expensive
PM System Hospital
Imaging
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22. Fully Integrated
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23. Implementation and
Selection Strategies
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24. Career Defining Moments in
Healthcare Management
A new physician
A Construction Project compensation
plan An I.T. Project
IT
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25. There is significant amount of pressure, but
little clarity regarding its affect, priority, or
implication
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26. OBTAINING PHYSICIAN BUY-IN AND
BUILDING INCENTIVES
There are two simple considerations when
seeking physician b i
ki h i i buy-in:
1. Do they want it?
2. Will they use it?
© 2010 The Coker Group 26

27. What is your physician
culture?
O e the
Over t e top “tech-
tec
savvy” MD’s who will Pen & Paper will do me
shoot you with an just fine. You don’t get
infra-red beam from a paid for typing !
Palm-Pilot
Palm Pilot
Or BOTH
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28. Reengineering the Process
Will Require New Automation
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Automate the “Old” Way
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29. Automation
“Automating a bad process not only ensures
that we can do a bad job every time, but that
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we can do it faster and with less effort than
before.”
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30. Estimated Rate of
Ambulatory EHR Failure
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 According to some researchers there has been
a 30-40% failure rate of EHR implementations
30 40%
 These failures are a result of:
 Lack of implementation planning
 Inadequate research and expectations of technology
 Incomplete training of staff
 Mismanagement of workflow and staffing changes
 Reluctance of providers to take on additional burden
© 2010 The Coker Group 30

31. Implementing Technology
The “Happy” / “Sad” Analysis
ppy y
HAPPY
SAD
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32. Prerequisites for Complex Change
Action Desired
Vision Skills Incentives Resources Results
Plans
1 Action
X Skills Incentives Resources
Plans Confusion
Conflicts
Vision Action
2 X Incentives Resources Performance
Plans
Anxiety
3 Action Back-
k
Vision Skills X Resources
Plans Sliding
Action Frustration
4 Vision Skills Incentives X & Anger
g
Plans
False
5 Vision Skills Incentives Resources X Starts
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33. Top 10 Critical Success
Factors
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34. 1 - Enthusiastic EMR Project
Leader
The person driving the project is the number one
success f t f an Electronic M di l R
factor for El t i Medical Record d
Implementation!
 A Physician committed to the project.
 A respected staff member.
 Sets expectations and goals for group
 Understands EMR product capabilities
 Positive attitude and enthusiasm!
© 2010 The Coker Group 34

35. 2 - A Implementation Plan
 Figure out the business case – costs,
patient flow, increased efficiency
ti t fl i d ffi i
 Get buy-in – commitment from all
 Consider your options – EMR selection
 Ensure support – Training service,
Training, service
support
 Prepare to change – develop strategy
for handling bumps – be emotionally
ready
 Consider increments
© 2010 The Coker Group 35

36. 3 - Good EMR product and
Vendor
 Don’t try to write your own EMR
 Do reference calls and site visits
 Look for excellent support
pp
 Expect to do your part in the
implementation
 Templates
 Learn the product
© 2010 The Coker Group 36

37. 4 - Training
 For the project leader - Vendor
supplied, CDs,
supplied CDs Online Tutorials Self
Tutorials, Self-
learning
 F the EMR end user - O
For th d One-on-one
training seems to give the best results
 Learn one, d one, teach one
L do h
© 2010 The Coker Group 37

38. 5 - Provide your staff with
multiple data entry methods
 Typing
 Templates & “Macros”
V i R
Voice Recognition – S
iti SpeechMike, A
hMik Array
Mike
 Handwriting Recognition – Pen Tablet
PCs
 Scanning
 Interfaces
 Dictation with Transcription in EMR
© 2010 The Coker Group 38

39. 6 - A Solid Infrastructure
 You need a reliable Internet connection
 Certified CAT 5, 5e, 6 or 6e wiring
 Certify the equipment before going live
 Test
 Test
T t
 Test
 Try to break it
© 2010 The Coker Group 39

40. 7 - Quality Hardware
 Tablets
 PCs
 COWs
 Nurse/MD on a Sti k
N /MD Stick
 Printers with network connections
 Scanners
 Back up
Back-up
© 2010 The Coker Group 40

41. 8 – Good computer
support
 A company you trust for advice and
pp
support
 Takes an interest in what you are trying
p
to accomplish
 Provides prompt support and returns
calls
 Does preventive maintenance
 Does upgrades and patches
© 2010 The Coker Group 41

42. 9 – Watch out for Interface
Promises
Interfaces can take months to complete!
 Find out exactly what is interfaced
 Demographics
 Scheduling
 Charges
Ch
 Has it been done before? Ask for a reference.
 Does the price include both vendors
p
 Consider looking up information on another system
instead of interfacing
© 2010 The Coker Group 42

43. 10 – Ownership
 Executive Sponsorship
 Physician Champion
 Strong Leadership
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44. Tools for Averting Risk
 Statement of work
 Request for proposal
 Payment terms tied to p j
y project milestones
 Progress reports
 Customized implementation plan
 Project budget
 Project staffing plan
© 2010 The Coker 44
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45. Sample Tools
For a complimentary templates
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please sent request to
q
jdaigrepont@cokergroup.com
© 2010 The Coker 45
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46. Modifying the Contract
 Source Code
 Acceptance Period (Hardware & Software)
 Implementation Caveats
 Statement of Work (SOW)
 No Front Loading of Support Fees
 No Front Loading the purchase terms
 Assignment
 Future Upgrades and New Releases
 Copyright infringements
 Warranties
 Termination
 Future providers and fees (Recurring cost)
© 2010 The Coker Group 46

47. Final Thought -
Fi l Th ht
Five Stages Of EMR
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*Elizabeth Kubler-Ross
Death and Dying

48. 1st Stage: Denial
 Occurs from time of purchase
until first few days of go-live
 Sees only benefits of EMRs
 Denial of any difficulties
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49. 2nd Stage: Anger
 Typically lasts one
month
 Angry because of
reduced patient
volumes
 Staff upset with new
system
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50. 3rd Stage: Bargaining
 Lasts 2-4 weeks
 Pl d with vendor t
Plead ith d to
make program work
 Will d anything
do thi
© 2010 The Coker Group 50

51. 4th Stage: Depression
 Lasts 3-6 months
 A
Assume program will ill
not work
 C ’t abandon it
Can’t b d
since it costs so much
© 2010 The Coker Group 51

52. 5th Stage: Acceptance
 It all starts to fall into
place
 See benefits from the
system
 You and every one
else live happily ever
after!
 Cause for celebration
© 2010 The Coker Group 52

53. Thank You
Contact Information
Jeffery Daigrepont, Principal
y g p , p
The Coker Group
jdaigrepont@cokergroup.com
j g @ g
800-345-5829
© 2010 The Coker Group 53